Avaliação dos medicamentos utilizados e possíveis interações medicamentosas em doentes renais crônicos
DOI:
https://doi.org/10.15448/1980-6108.2014.4.17637Palavras-chave:
INTERAÇÕES DE MEDICAMENTOS, INSUFICIÊNCIA RENAL CRÔNICA, UNIDADES HOSPITALARES DE HEMODIÁLISEResumo
OBJETIVOS: Descrever os medicamentos mais frequentemente utilizados por pacientes em hemodiálise e identificar potenciais interações medicamentosas entre os mesmos. MÉTODOS: Estudo transversal realizado em uma unidade hospitalar de hemodiálise. Cada combinação de medicamentos prescritos foi analisada no programa Micromedex©2014 Truven Health Analytics (Michigan, Estados Unidos), para identificação de potenciais interações medicamentosas e classificação de acordo com a gravidade. RESULTADOS: Foram incluídos 65 pacientes. A média de idade foi de 59,1±14,7 anos e 50,8% eram mulheres. A ocorrência de polifarmácia foi de 87,7%, com média de 6,3±3,1 medicamentos por paciente, sendo os mais frequentes o carbonato de cálcio (n=55, 84,6%) e a eritropoetina (n=47, 72,3%). A prevalência de potenciais interações medicamentosas foi de 56,9%, com mediana de uma interação por paciente, e a maioria foi classificada como moderada (49,1%), sendo as mais frequentes atenolol/carbonato de cálcio (n=9, 8,0%) e ferro/carbonato de cálcio (n=9, 8,0%). A presença de potenciais interações medicamentosas moderadas ou importantes e o número destas associaram-se com a quantidade de medicamentos utilizados por paciente (p<0,001). CONCLUSÕES: A prevalência de potenciais interações medicamentosas nos pacientes em hemodiálise foi elevada e esteve intimamente ligada ao número de medicamentos utilizados por cada paciente. A população com doença renal crônica necessita do uso de vários medicamentos, portanto é importante a seleção cuidadosa de alternativas terapêuticas, através da assistência farmacêutica, para o uso eficaz, racional e seguro de medicamentos.Downloads
Referências
International Society of Nephrology. Kidney Disease Improving Global Outcomes. KDIGO 2012 Clinical Practice Guidelines for the Evaluation and Management of Chronic Kidney Disease. Kidney Int Suppl. 2013;3(1):1-150.
Stemer G, Lemmens-Gruber R. Clinical pharmacy activities in chronic kidney disease and end-stage renal disease patients: a systematic literature review. BMC Nephrol. 2011;12:35.
Joshua L, Devi PD, Guido S. Adverse drug reactions in nephrology ward inpatients of a tertiary care hospital. Indian J Med Sci. 2007;61(10):562-9.
Goldberg RM, Mabee J, Chan L, Wong S. Drug-drug and drug-disease interactions in the ED: analysis of a high-risk population. Am J Emerg Med. 1996;14(5):447-50.
Magro L, Conforti A, Del Zotti F, Leone R, Iorio ML, Meneghelli I, Massignani D, Visonà E, Moretti U. Identification of severe potential drug-drug interactions using an Italian general-practitioner database. Eur J Clin Pharmacol. 2008;64(3):303-9.
Bucşa C, Farcaş A, Cazacu I, Leucuta D, Achimas-Cadariu A, Mogosan C, Bojita M. How many potential drug-drug interactions cause adverse drug reactions in hospitalized patients? Eur J Intern Med. 2013;24(1):27-33.
Malone DC1, Abarca J, Hansten PD, Grizzle AJ, Armstrong EP, Van Bergen RC, Duncan-Edgar BS, Solomon SL, Lipton RB. Identification of serious drug-drug interactions: results of the partnership to prevent drug-drug interactions. J Am Pharm Assoc. 2004;44(2):142-51.
Sepehri G, Khazaelli P, Dahooie FA, Sepehri E, Dehghani MR. Prevalence of potential drug interactions in an Iranian general hospital. Indian J Pharm Sci. 2012;74(1):75-9.
Teixeira JJ, Crozatti MT, dos Santos CA, Romano-Lieber NS. Potential drug-drug interactions in prescriptions to patients over 45 years of age in primary care, southern Brazil. PLoS One. 2012;7(10):e47062.
Gagne JJ, Maio V, Rabinowitz C. Prevalence and predictors of potential drug-drug interactions in Regione Emilia-Romagna, Italy. J Clin Pharm Ther. 2008;33(2):141-51.
Cruciol-Souza JM, Thomson JC. A pharmacoepidemiologic study of drug interactions in a brazilian teaching hospital. Clinics. 2006;61(6):515-20.
Glintborg B, Andersen SE, Dalhoff K. Drug-drug interactions among recently hospitalized patients - frequent but mostly clinically insignificant. Eur J Clin Pharmacol. 2005;61(9):675-81.
Cruciol-Souza JM, Thomson JC. Prevalence of potential drug-drug interactions and its associated factors in a Brazilian teaching hospital. J Pharm Pharm Sci. 2006;9(3):427-33.
Vonbach P, Dubied A, Krähenbühl S, Beer JH. Prevalence of drug-drug interactions at hospital entry and during hospital stay of patients in internal medicine. Eur J Intern Med. 2008;19(6):413-20.
Grönroos PE, Irjala KM, Huupponen RK, Scheinin H, Forsström J, Forsström JJ. A medication database - a tool for detecting drug interactions in hospital. Eur J Clin Pharmacol. 1997;53(1):13-7.
Bjerrum L, Andersen M, Petersen G, Kragstrup J. Exposure to potential drug interactions in primary health care. Scand J Prim Health Care. 2003;21(3):153-8.
Björkman IK, Fastbom J, Schmidt IK, Bernsten CB. Pharmaceutical Care of the Elderly in Europe Research (PEER) Group. Drug-drug interactions in the elderly. Ann Pharmacother. 2002;36(11):1675-81.
Bergendal L, Friberg A, Schaffrath A. Potential drug-drug interactions in 5125 mostly elderly out-patients in Gothenburg, Sweden. Pharm World Sci. 1995;17(5):152-7.
Costa AJ. Potential drug interactions in an ambulatory geriatric population. Fam Pract. 1991;8(3):234-6.
Rosholm JU, Bjerrum L, Hallas J, Worm J, Gram LF. Polypharmacy and the risk of drug-drug interactions among Danish elderly. A prescription database study. Dan Med Bull. 1998;45(2):210-3.
Riemer E, Werling E, Kribs M, Hamman De Compte A, Dimitrov Y. Medical prescriptions in haemodialysis patients: critical analysis. Nephrol Ther. 2005;1(4):234-40.
Rama M, Viswanathan G, Acharya LD, Attur RP, Reddy PN, Raghavan SV. Assessment of Drug-Drug Interactions among Renal Failure Patients of Nephrology Ward in a South Indian Tertiary Care Hospital. Indian J Pharm Sci. 2012;74(1):63-8.
Marquito AB, Fernandes NM, Colugnati FA, de Paula RB. Identifying potential drug interactions in chronic kidney disease patients. J Bras Nefrol. 2014;36(1):26-34.
Vonbach P, Dubied A, Beer JH, Krähenbühl S. Recognition and management of potential drug-drug interactions in patients on internal medicine wards. Eur J Clin Pharmacol. 2007;63(11):1075-83.
WHO Collaborating Centre for Drug Statistics Methodology. Guidelines for ATC classification and DDD assignment 2014. Oslo: Norwegian Institute of Public Health; 2013.
Moreira LB, Fernandes PFBC, Monte FS, Martins AMC. Adesão ao Tratamento Farmacológico em Pacientes com Doença Renal Crônica. J Bras Nefrol. 2008;30(2):113-9.
Moreira LB, Fernandes PFBC, Monte FS, Galvão RIM, Martins AMC. Conhecimento sobre o tratamento farmacológico em pacientes com doença renal crônica. Rev Bras Cienc Farm. 2008;44(2):315-25.
Manley HJ, McClaran ML, Overbay DK, Wright MA, Reid GM, Bender WL, Neufeld TK, Hebbar S, Muther RS. Factors associated with medication-related problems in ambulatory hemodialysis patients. Am J Kidney Dis. 2003;41:386-93.
Manley HJ, Drayer DK, Muther RS. Medication related problem type and appearance rate in ambulatory hemodialysis patients. BMC Nephrol. 2003;4:10.
Grabe DW, Bailie GR, Manley HJ, Yeaw BF. The early patient-orientated care program as an educational tool and service.Am J Pharm Educ. 1998;62:279-84.
Grabe DW, Low CL, Bailie GR, Eisele G. Evaluation of drug-related problems in an outpatient hemodialysis unit and the impact of a clinical pharmacist. Clin Nephrol. 1997;121:459-64.
Sánchez-Gili M, Toro-Chico P, Pérez-Encinas M, Gómez-Pedrero AM, Portolés-Pérez JM. Pharmaceutical intervention on the therapeutic adherence in patients with chronic renal disease. Rev Calid Asist. 2011;26(3):146-51.
Rifkin DE, Laws MB, Rao M, Balakrishnan VS, Sarnak MJ, Wilson IB. Medication adherence behavior and priorities among older adults with CKD: a semistructured interview study. Am J Kidney Dis. 2010;56(3):439-46.
Fokter N, Mozina M, Brvar M. Potential drug-drug interactions and admissions due to drug-drug interactions in patients treated in medical departments. Wien Klin Wochenschr. 2010;122(3-4):81-8.
Loya AM, González-Stuart A, Rivera JO. Prevalence of polypharmacy, polyherbacy, nutritional supplement use and potential product interactions among older adults living on the United States-Mexico border: a descriptive, questionnaire-based study. Drugs Aging. 2009;26(5):423-36.
Correr CJ, Pontarolo R, Ferreira LC, Baptistão SAM. Riscos de problemas relacionados com medicamentos em pacientes de uma instituição geriátrica. Rev Bras Cienc Farm. 2007;43(1):55-62.
Janchawee B, Wongpoowarak W, Owatranporn T, Chongsuvivatwong V. Pharmacoepidemiologic study of potential drug interactions in outpatients of a university hospital in Thailand. J Clin Pharm Ther. 2005;30(1):13-20.
Yunes LP, Coelho TA, Almeida SM. Principais interações medicamentosas em pacientes da UTI-adulto de um hospital privado de minas gerais. R Bras Farm Hosp Serv Saúde São Paulo. 2011;2(3):23-6.
Nabovati E, Vakili-Arki H, Taherzadeh Z, Hasibian MR, Abu-Hanna A, Eslami S. Daru. Drug-drug interactions in inpatient and outpatient settings in Iran: a systematic review of the literature. Daru. 2014;22:52.
Tannenbaum C, Sheehan NL. Understanding and preventing drug-drug and drug-gene interactions. Expert Rev Clin Pharmacol. 2014;7(4):533-44.
Belaiche S, Romanet T, Bell R, Calop J, Allenet B, Zaoui P. Pharmaceutical care in chronic kidney disease: experience at Grenoble University Hospital from 2006 to 2010. J Nephrol. 2012;25(4):558-65.
Mason NA. Polypharmacy and medication-related complications in the chronic kidney disease patient. Curr Opin Nephrol Hypertens. 2011;20(5):492-7.
Mason NA, Bakus JL. Strategies for reducing polypharmacy and other medication-related problems in chronic kidney disease. Semin Dial. 2010;23(1):55-61.
